Leukemia - Chronic T-Cell Lymphocytic

ON THIS PAGE : You will find out more about the factors that increase the chance of developing T-cell leukemia. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of leukemia, most do not directly cause the disease. Some people with several risk factors never develop leukemia, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

In general, leukemia occasionally can be caused by a genetic mutation or change. These may be genetic mutations passed from generation to generation within a family or from environmental factors, such as smoking or exposure to chemicals or radiation. However, most often the cause of leukemia is not known.

The following risk factor can increase a person’s chance of developing T-cell leukemia:

• Race/Ethnicity. ATLL is more common in people of Japanese, West Indian, and African American descent.

The next section in this guide is Symptoms and Signs . It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many blood and bone marrow tests to diagnose leukemia. They also do tests to learn how much it may have spread. Doctors may also do tests to learn which treatments could work best.

A patient’s signs and symptoms may cause a doctor to suspect leukemia. But, blood and/or bone marrow tests are the only way to know whether a person has leukemia.

This list describes options for diagnosing T-cell leukemia. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of leukemia suspected

• Your signs and symptoms

• Your age and medical condition

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose T-cell leukemia:

• Blood tests. The diagnosis of T-cell leukemia begins with a blood test called a complete blood count (CBC) . A CBC measures the numbers of different types of cells in the blood. If the blood contains many white blood cells, T-cell leukemia may be suspected.

• Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle.

  A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand. Other types of anesthesia (medication to block awareness of pain) may also be used.

• Molecular testing. Your doctor may recommend running laboratory tests on a bone marrow sample to identify specific genes, proteins, and other factors unique to the disease.

  • Immunophenotyping is the examination of antigens, a specific type of protein, on the surface of the leukemia cells. Immunophenotyping allows the doctor to confirm the exact type of leukemia.

  • Cytogenetics is the examination of the leukemia cells for abnormal changes to the long strands of genes called chromosomes. It helps doctors confirm the diagnosis and may help determine the person’s chance of recovery.

  Results of these tests will also help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options ).

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). In addition to a bone marrow aspiration and biopsy (see above), the following types of biopsy may be needed depending on the type of T-cell leukemia suspected:

  • Skin biopsy. During a skin biopsy, a sample of skin tissue is removed to look for T cells in the skin.

  • Lymph node biopsy. In a lymph node biopsy, the doctor removes all or part of a lymph node to look for leukemia cells.

• Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities, including swollen lymph nodes or a swollen spleen. A CT scan can be used to measure the size of a swollen lymph node. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is leukemia, these results also help the doctor describe the disease.

The next section in this guide is Stages . It explains how doctors describe the growth or spread of most types of cancer, called stage, and how this differs for T-cell leukemia. You may use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will learn about the different treatments doctors use for people with T-cell leukemia. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of leukemia. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team . Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The goal of treatment for a blood-related cancer is to bring about a remission. A remission is when leukemia cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

Descriptions of the most common treatment options for T-cell leukemia are listed below, followed by an outline of the treatment options by each subtype. Treatment options and recommendations depend on several factors, including the type and subtype of leukemia, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions .

Active surveillance/watch and wait

During active surveillance, people with leukemia are monitored with blood and other tests at regularly scheduled checkups. These checkups are done to track blood cell counts and look for other signs that the disease is worsening. Studies have shown that, for people with certain disease features, active surveillance is not harmful when compared with starting treatment earlier.

Treatment begins when people develop signs that the disease is worsening, such as increasing fatigue, night sweats, enlarged lymph nodes, or decreasing blood cell counts. People with leukemia are encouraged to talk with their doctors about whether their symptoms need treatment, and to consider the benefits of treatment compared with the side effects of treatment.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. The specific drugs used for T-cell leukemia are listed further below under “Treatments specific to T-cell subtype.”

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment . The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.  Learn more about your prescriptions by using searchable drug databases .

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the leukemia. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Recombinant interferon alpha (Alferon, Infergen, Intron A, Roferon-A) is used as a treatment for ATLL. Interferon is a natural protein found in the body that stimulates the immune system.

Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects of the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all cancers have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors involved in your leukemia. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

For T-cell leukemia, a type of targeted therapy called a monoclonal antibody may be used. It recognizes and attaches to a specific protein on the surface of the leukemia cells. It does not affect cells that don’t have that protein, which can kill some of the leukemia cells. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Radiation therapy

Radiation therapy is the use of x-rays or other high-energy particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.  Learn more about the basics of radiation therapy .

Surgery

Surgery to remove the spleen, which also makes white blood cells, is called a splenectomy. This type of surgery may be recommended for some patients. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of surgery .

Stem cell transplantation/bone marrow transplantation

A stem cell transplant is a medical procedure in which bone marrow that contains leukemia is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Stem cell transplantation is not a common treatment option for people with T-cell leukemia, because it is not always an effective treatment for this disease and because many patients with this disease are older and the risks of the procedure are higher.  Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of leukemia, results of any previous treatment, and patient’s age and general health.

There are 2 types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. ALLO transplants are the more common type used for patients with chronic T-cell leukemia.

In both types, the goal is to destroy all of the leukemia cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.

Side effects depend on the type of transplant, your general health, and other factors. Learn more about the basics of stem cell and bone marrow transplantation .

Getting care for symptoms and side effects

Leukemia and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the leukemia at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the leukemia, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care .

Treatments specific to T-cell leukemia type

• LGLL. For LGLL, active surveillance is sometimes recommended during its early stages, with treatment beginning once symptoms develop. When treatment for the disease is needed, LGLL can be treated with drugs that lower the immune system:

  • Cyclosporine (Gengraf, Neoral, Sandimmune), which may also be used when low neutrophil and platelet levels cause problems

  • Cyclophosphamide (Neosar)

  • Low-dose methotrexate (multiple brand names)

  Sometimes, low levels of neutrophils cause infections that need antibiotics. Treatment with growth factors, such as filgrastim (Neupogen, Zarxio), which can stimulate the growth of neutrophils, is sometimes used when infections from low neutrophil counts become a problem. Treatment with a combination of drugs is sometimes used if the disease is worsening quickly. The combination is similar to that used for aggressive lymphoma. Learn more about non-Hodgkin lymphoma treatment .

• T-PLL. T-PLL may be treated with the following drugs:

  • Fludarabine (Fludara)

  • Chlorambucil (Leukeran)

  • Cyclophosphamide

  • Doxorubicin (Adriamycin)

  • Vincristine (Vincasar)

  • Pentostatin (Nipent)

  • Prednisone (multiple brand names)

  • Alemtuzumab (Campath), a monoclonal antibody (see Targeted therapy above) that has helped manage T-PLL for some patients

• Adult T-cell leukemia/lymphoma (ATLL). ATLL may be treated with zidovudine (Retrovir) and recombinant interferon alpha if it is in the chronic or acute phase. The goal of treatment is to strengthen the immune system and treat the human T-cell leukemia virus (HTLV). The lymphoma phase is usually treated with combination chemotherapy.

• Sezary syndrome. Treatments for Sezary syndrome may be focused on the skin or may include systemic whole-body treatments. Skin treatments include the following.

  • Skin creams

  • The use of light to kill cancer cells, called phototherapy

  • Radiation therapy, including total skin electron-beam radiation therapy, which can treat the entire surface of the skin.

  Systemic treatments for Sezary syndrome include the following. The choice of treatment depends on the extent of the disease, as well as other factors.

  • Chemotherapy

  • Oral bexarotene (Targretin), a drug that is similar to vitamin A

  • Denileukin diftitox (Ontak), an antibody which helps deliver a drug directly to the leukemia cells

  • Alpha interferon

  • Sometimes, ALLO stem cell transplantation

  • Alemtuzumab may also be effective

  • Vorinostat (Zolinza) and romidepsin (Istodax) for cutaneous (skin) T-cell lymphoma if other treatments do not work

Refractory T-cell leukemia

If the leukemia continues to worsen despite treatment, it is called refractory leukemia. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan that includes may include a combination of chemotherapy, immunotherapy, and targeted therapy. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of refractory leukemia is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when leukemia cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the leukemia will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the leukemia returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the disease does return. Learn more about coping with the fear of recurrence .

If the leukemia does return after the original treatment, it is called recurrent leukemia. When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as chemotherapy, immunotherapy, targeted therapy, and stem cell transplantation, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent leukemia. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent leukemia often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with a recurrence .

If treatment doesn’t work

Recovery from leukemia is not always possible. If the leukemia cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced leukemia is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced leukemia and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will read about the scientific research being done now to learn more about this T-cell leukemia and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about T-cell leukemia, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• New treatment combinations. New treatments are being tested in clinical trials, including new combinations of chemotherapy and immunotherapy. For ATLL, several new treatments are being studied including bortezomib (Velcade), arsenic trioxide (Trisenox), and daclizumab (Zenapax), which is an anti-IL2 antibody. Romidepsin is also being researched for patients with mycosis fungoides.

• Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current T-cell leukemia treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding leukemia, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now .

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, and social changes that T-cell leukemia and its treatment can bring. You may use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will read about your medical care after treatment is completed, and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with leukemia doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the disease has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, blood tests, bone marrow biopsies, and possibly scans or other imaging tests. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Leukemia recurs because small areas of leukemia cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors including the type of leukemia originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Several long-term side effects from leukemia treatment may occur:

• Lung damage from certain drugs or radiation therapy to the chest.

• A weakened heart muscle from higher doses of doxorubicin or radiation therapy to the chest.

• Infertility (inability to have a child) or early menopause from high-dose cyclophosphamide or other drugs.

• Higher risk of infection from some drugs, specifically with alemtuzumab, even after treatment ends.

• A secondary leukemia or other secondary cancer that develops because of the treatment for the first type of cancer. This is more common from chemotherapy and radiation therapy.

Talk with your doctor about your risk of developing such side effects based on the type of leukemia, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type of leukemia, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your care for leukemia will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a diagnosis of T-cell leukemia. You may use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with your health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

• What is the exact type of T-cell leukemia that I have?

• Can you explain my pathology report (laboratory test results) to me?

• How aggressive is my disease? Is it curable?

• Is it possible to stop its development?

• How can my symptoms be controlled? For how long?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the leukemia, manage the symptoms and side effects, or both?

• Do I need to start treatment right away?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• What are the possible side effects of this treatment, both in the short term and the long term?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before treatment begins?

• If I’m worried about managing the costs of medical care, who can help me?

• How can I keep myself as healthy as possible during treatment?

• What support services are available to me? To my family?

• Whom should I call with questions or problems?

• Is there anything else I should be asking?

Questions to ask about having chemotherapy, targeted therapy, immunotherapy, or radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment?

• What are the possible long-term effects of having this treatment?

• What can be done to relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the leukemia will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the treatment I received?

• What follow-up tests will I need, and how often will I need them?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?
  

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

• Are other members of my family at a higher risk for leukemia?

The next section in this guide is Additional Resources . It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.